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1. 2 Patient s Last Name Patient s First Name Patient s Middle Initial Row oHN A 5 Patient s Street Address Patient s City Patient s State f0OMAINSTREET BIRMINGHAM aaam Patient s Zip Patient ID Code Patient s Sex psa XAA123456789 MAE x 3 Patient s Date of Birth ape A0EKUNI Number fioieig70 987654321 SERVICE INFORMATION This section contains the information related to the medical services rendered to the patient by the provider The field number corresponds to the box number on the HCFA 1500 CL 4 form Review this screen and answer any questions that are valid for this claim Once completed click the Continue button to save your information and advance to the next step The Reset Form button will return all data fields back to the original values BlueCross BlueShield of Alabama Service Information Batch List Provider 51012345 Contract Number XAA123456789 Priman insurance Info Secondary Insurance Info Dates must be in mmddyyyy format Patient Service Date Claims List John A Brown 09 02 2003 Patient Info Reset Form Service Info Line ltem Info Professional WebClaims User Manual Rev 10 01 2003 14 Date of Current Illness Injury or Pregnancy 10a Is Patient s condition employment No related 15 If Patient has had same or similar illness give first date 17 Last N f Referring Physici 16 Dates Patient unable to work in pie a c
2. Upload NSF Claim File oo0oo0o0o0 e Payment Information Institutional Online Remittance Report Institutional Refund Balance Activity Report Professional Online Remittance Report Professional Refund Balance Activity Report Pharmacy Online Remittance Report Payment History Refund Billing Invoices Download NSF Remittance File Institutional Activity Summary Report ooo0o00o000 6 User manuals are also available from this page Page 3 of 18 WELCOME TO PROVIDER ACCESS From the Provider Access main page use your mouse and click the Claim Entry WebClaims link to enter the WebClaims Application hy BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agour Us CONTACT Us Return to Providers ProwiderAccess User hianuals Sign Out Help Welcome to ProviderAccess You are signed in as 51012345 Please select the e Practice Management application you would like ta perform from the list below To perform additional transactions please return to this page to select your next function Patient Information o Eligibility and Benefits o Summary Plan Description o FA Patient Medical Information Claim Information o Claim Entr ebClaims o Mew Audit Trail o Audit Trail o Audit Trail Error Descriptions o Claim Status o Upload NSF Claim File Payment Information Institutional Online
3. reate dynamk Adobe POF forms AGG itchy motes and other elec toni commend within yout Web beow1er A A QAR RQ QA Conwert Web capes to Adobe POF fies with 28 Boks Intact for one viewing taii Convert any document to Adobe POF including Ma scroft Office Word Erce aS Power Pont document o Create rondde tugged Adobe PDF fier for viewing wah Acrobat Reader for f handhetd deve ot Just for eBooks Ort Acrobat PGet Acrobat Get Acrobat gt Get Acrobat 5 0 AR A thook Reader Reader Approval 5 0 works j aos om 249 00 gt 39 e I intemet Professional WebClaims User Manual Rev 10 01 2003 Page 14 of 18 Once you have selected Submit then the next screen will show that it is processing your request The Batch Message shows that the file was received mie a AUDIT REPORT We are processing your request This may take several minutes depending on the size of the audit report m n A A DORE gt de on o el aeS b S B 2 BSG E Uw Bookmark i Provider ID BlueCross BlueShield zm If a provider and date are Ea OTN of Alabama selected and a batch message ae ooon does not appear then claims r ees AUDIT REPORT or a file were not received Sa aae wean aes Gee wee pa T on that particular date 151 0xxx eee ee eeepc 01 Oxxxxx SUBMITTER HIPAATST TEST PROVIDER1 07 16 03 31 Oxxxxx lt NMESSAGE gt FILE UNZIPPED SUCCESSFULLY i o y 51 OXxxxx lt MESSAGE gt FILE UNZIPPED SUCCESSFULLY Cu
4. www bcbsal org edi instucthtm dow Go EB Jero OR a Qagla a0 Download the Software Adobe Acrobat Reader allows you to view navigate and print PDF files Adobe Acrobat is NOTE It is necessary to have the free and relatively easy to download and install Adobe Acrobat Reader for the most common platforms is available at no cost Adobe Acrobat Reader software installed on your computer in order to view print the audit trail reports FAN co a Adobe Click the Get Acrobat Reader box to download the free version of Adobe Acrobat Reader Nail A Internet If you have trouble viewing the report or do not already have the software installed on your computer download the free version of the Z Adobe Acrobat Reader Download Microsoft internet Explorer Eile Ede Yiew Favontes Toots Help Address hro wew adobe com products acrobat readstep html Go a Adobe Acrobat Reader QO O00 a a software Clicking the download link Adobe k Store i Products Support Corporate will open up a browser window taking TEE E Downloads Tryouts Registration you directly to the download page Follow the download instructions and install the software Once installed return to the Online Audit Trail Retrieval Page and repeat steps serie ___ above o Semm Gonmmenate pount ahangn Acrobat Acrobat Reader 5S0 Approval SO Acrobat 50 sd KINIA IA ISIS
5. Md gt We olhs D ODES a E S B 0 2 BS 000 6 w A Bookmark v lt B SL Provider ID J BlueCross BlueShield 2 Apes Message UY J of Alabama 8 bed eo 510xxxxx g 51 0xxxxx lcm AUDIT REPORT E 7 510xxxxx e aad L 3 E 07 16 2003 gt XXXXX A FUS 0woax PROVIDER 51099999 TEST PROVIDERI ACCEPTED CLAIMS 5 tl cain M reese eee ee E p 510XXXXX BLUE SHIELD CLAIMS 5 o LOK ee ge ee ee a a ee nee 510xxxxx CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES 8 1 51 Oxxxxx XAA999999901 PATIENT1 A B 03 22 03 03 22 03 270 00 g 1 51 0xxxxx CLAIM NBR 551 1110001 Bl LS 1 Oxxxx TST40601 i 1 510xxxxx E P a ee eee phan CONT NED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES ge ens PP4999999902 PATIENT2 C D 03 18 03 03 18 03 170 00 0 CLAIM NBR 551 1110002 TST40607 CONT MED REC PAT CNTL PATIENT NAME FROMN DOS THRU DOS CLAIN CHARGES x aa999999903 PATIENT3 E F 03 22 03 03 22 03 138 00 CLAIM NBR 551 1110003 TST40640 AL HH Done Internet Professional WebClaims User Manual Rev 10 01 2003 Page 15 of 18 The Audit Report will show a total of Claims Accepted in cluding the number of claims accepted for the total dollar amount accepted Rejected Claims immediately follows the Accepted Claims totals This section contains a list of all claims that were re jected Each of these claims will have an associated error number and message
6. John A Brown Contract Number XAA123456 789 Service Date 09 02 2003 Primary Insurance Info Secondary Insurance info Patient Info Service Info Line item Info Raa Dates must be in mmddyyyy format 9 Other Insured s Name Last First Middle Insured s Address Street City State Zip ALABAMA z NOTE Electronic Secondary Claim Submission is not available at this time Page 8 of 18 PATIENT INFORMATION This section contains the patient s demographic information The field number corresponds to the box number on the HCFA 1500 CL 4 form Some information on this screen may be populated automatically based on the contract number keyed and member se lected when adding the claim Read each field carefully and make any necessary changes Review the patient information to make sure all questions are answered and pre populated fields are accurate Click the Continue button to save your information and advance to the next step The Reset Form button will re turn all data fields back to the original values pare D BlueCross BlueShield of Alabama Patient Information Batch List Provider 51012345 Patient Contract Number XAA123456789 Service Claims List John A Brown Date 09 02 2003 Priman insurance info Secondary Insurance info Patient Info Service Info Line item Info Dates must be in mmddyyyy format Reset Form
7. Male 7 Please enter the latest date of service for this 09022003 claim a Reset Provider Billing ID ProviderAccess Home Sign out MMDDYYYY For questions or problems with these web pages Page 7 of 18 PRIMARY INSURANCE INFORMATION This section contains the patient s primary insurance information The field number in parentheses corresponds to the box number on the HCFA 1500 CL 4 form Some information on this screen may be populated automatically based on the contract number keyed and member selected when adding the claim Read each field carefully and make any necessary changes Any information we have on file will be populated automatically in the appropriate fields Review this information and make any necessary changes Click the Continue button to save your BlueCross BlueShield of Alabama Primary Insurance Information Batch List Claims List Provider 51012345 Patient John A Brown Contract Number XAA123456789 Service Date 09 02 2003 Primary insurance Info Secondary Insurance Info Patient Info Service Info Line item Info information and advance to the Reset Form next step Dates must be in mmddyyyy format 4 Insured s Name Last BROWN First JOHN Middle A The Reset Form button will return 7 Insured s Address all data fields back to the original alba fi 00 MAIN STREET ANYTOWN values ae on ALABAMA gt 35244 11 Insured s Policy G
8. to delete the batch that contains all the above listed claims Delete Batch Click the submit button to send the batch for processing by BCBSAL After submitting the batch you e Geis Eo Geek will be returned to the Batch E A NA E Submission Maintenance Batch List page BATCH SUBMISSION MAINTENANCE Batch List A listing of pending and submitted batches After the batch is received by Blue Cross the status will change from REMEMBER BlueCross BlueShield Pending to Submitted Batches labeled of Alabama Pending Batch Submission Maintenance have not yet Professional Dental Home Health j i 5101234 been received Provider Key 51012345 Provider Name John J Smith MD SO IMPORTANT Once your batch Date Created Batch Type Created By Claims Count Total Amount Submitted Subnfission Status has been submitted refer to Page 01 03 2003 Professional EthanTest 2 1 138 35 j hs 01 03 2003 Dental EthanTest 1 564 23 12 for instructions on retrieving 01 07 2003 Home Health Test 3 234 56 Pending Audit Re orts 01 08 2003 Professions Scott s Test 2 261 45 Pending AUGIL NEPOrts 01 10 2003 Professional DM Test 7 1 400 00 Pending 01 17 2003 Professional 01172002 1 10 00 Submitted 03 26 2003 Dental dental batch test 5 0 00 Pending 07 02 2003 Professional HIPAATESTFILE 7 920 81 Submitted 07 02 2003 Home Health HIPAATESTFILE 3 520 00 Submitted 07 29 2003 Professional Test 0 00 Pending 08 04 200
9. 3 Professional tester 12 0 00 Pending Professional WebClaims User Manual Rev 10 01 2003 Page 11 of 18 An audit report is generated by Blue Cross that confirms Audit Report Retrieval the receipt of your electronic claims This report specifies whether the submitted claims were accepted for processing or rejected due to an error Normally if we receive your claims before approximately 3 30 p m an audit report will be available the fol lowing business day If we receive your claims after approximately 3 30 p m your audit report should be available after two business days Occasionally audit reports may be delayed an additional day IMPORTANT NOTE Audit reports are now available electronically for 60 business days An audit report should be retrieved for every date of claims submission From the Provider Access page use your mouse and click on the Audit Trail link BlueCrossBlueShield f of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ABOUT Us Contact Us Return to Providers ProviderAccess User Manuals Sign Out Help Welcome to ProviderAccess You are signed in as 51012345 TIP If you are already logged Please select the e Practice Management application you would like to perform from the list below To into any other section of perform additional transactions please return to this page to select your next function Provider Access select the e e ai ProviderAccess link a
10. HARMACY FINDER CAREER OPPORTUNITIES EMERGENCY PATIENT INFORMATION PREFERRED LONG TERM CARE COMMUNITY RELATIONS INFOSOLUTIONS ELECTRONIC DATA INTERCHANGE SEARCH This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association All rights reserved Please see our Legal Disclaimer and Privacy Statement For Your Health Customers Employers Healthcare Providers Products amp Semices About Us Alabama Doctor Finder National Doctor Finder Pharmacy Finder Career Opportunities Emergency Patient Information Preferred Long Term Care Community Relations InfoSolutions Electronic Data Interchange Search Enter your Sign In and Password then click 3 the Submit button BlueCrossBlueShield j of Alabama CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Asout Us Contact Us The Caring Company ProviderAccess User Manuals Help 2 Click the ProviderAccess link HEALTHCARE PROVIDERS Blue CrossRlueShiiekl A Y of Alahania Hot Tonics Une PROVIDE APPU ATHOM IMIPOSOLUTIONS Pravo Asu AgouTUs CONTACTUS SIARCH Healthcare Providers Glue Cross appreciates the opportunity to work wah you in prowding the best available health care for you palais ard our subenkiers Abi est of rawiri lat carn help make d taser for you te reach us Frequently Used Phone Number
11. Home Sign out For questions or problems with these web pages A e BlueCross BlueShield of Alabama f Primary Insurance Information Batch List Claims List Provider 51012345 Patient John A Brown Contract Number XAA123456789 Service Date 09 02 2003 Primary insurance Info Secondary insurance info Patient Info Service Info Line Item Info Dates must be in mmddyyyy format 4 Insured s Name Last BROWN First JOHN Middle A 7 Insured s Address Street City 100 MAIN STREET BIRMINGHAM State Zip ALABAMA xi 35244 Fas VAY BlueCross BlueShield of Alabama Patient Information Batch List Claims List Provider 51012345 Patient John A Brown Contract Number yAA123456789 Service Date 09 02 2003 Primary Insurance Info Secondary Insurance Info Dates must be in mmddyyyy format Patient Info Service Info Line Item Info 2 Patient s Last Name BROWN Patient s First Name Patient s Middle Initial JOHN a 5 Patient s Street Address 100 MAIN STREET Patient s City BIRMINGHAM Patient s State ALABAMA v Patient s Zip Patient ID Code Patient s Sex 35244 XAA1 23456789 MALE 26 Patient s Account 3 Patient s Date of Birth Number Page 17 of 18 4 Once you have completed all of the changes go to the Procedure Information Line Item Information Screen and select Finish Claim You will be forwarded to the Claims Submission M
12. PProviderAccess www bcbsal com User Manual for Professional Providers WebClaims and Audit Trail Retrieval BlueCrossBlueShield Of Alabama An Independent Licensee of the Blue Cross and Blue Shield Association Professional WebClaims User Manual Rev 10 01 2003 Page 1 of 18 CONTACT NAMES AND NUMBERS 1 For connectivity or communication problems call all or e mail the Corporate Support Center at 205 220 6134 6 00 a m 5 30 p m CST SupportCenter bcbsal org 2 For other questions or problems e Check System Status on the Hot Topics page under the Providers section of the Blue Cross and Blue Shield of Alabama web page at http www bcbsal com e Contact your Network Data Operations Representative at 205 220 2533 HARDWARE REQUIREMENTS e Minimum Browser Requirements Netscape or Internet Explorer 4 0 or higher e Minimum Hardware Requirements for best results Screen resolution 640 x 480 Internet connection with at least 28 800 bps HELPFUL HINTS 1 If you leave the PC for a long period of time the application will time out You will need to close and restart your browser or if you have previously bookmarked your Provider Access Sign In page you may use your Favorites or Bookmark to access the Sign In page directly If you were keying a claim any information not previously saved will be lost 2 Use the Tab key not the Enter key when navigating thro
13. Remittance Report Institutional Refund Balance Activity Report Professional Online Remittance Report Professional Refund Balance Activity Report Pharmacy Online Remittance Report Payment History Refund Billing Invoices Download MSE Remittance File Institutional Activity Summary Report oo oO 0 00 90906 Fee Schedules PID Fee Schedule Chiropractor Fee Schedule DME Fee Schedule Home Health Fee Schedule Hospice Fee schedule Preferred CAT Fee Schedule Preferred MRI Fee Schedule Preferred OT and HT Fee Schedule Preferred PET Fee Schedule Preferred PT Fee Schedule Fee Schedule Individual Code e Guidelines and Policies o Fragmented Coding Edits o Medical Policies o CURP Medical Necessity Guidelines oO O09 O89 OO O00 8 Primary Care Network PCH Covering Physicians PCM Cost Profile Review Referral submit Referral Unique Provider Identification Number UPIN Reference oOo oO 8 8 Professional WebClaims User Manual Rev 10 01 2003 Page 4 of 18 PROVIDER BILLING INFORMATION 1 The 3 digit Plan Code i e 510 515 etc will automatically be populated based upon your login through Provider Access 2 The 5 digit Provider Number will automatically be populated based upon your login to Provider Access 3 Key in the Billing ID and press the Enter key or click the Submit button Verify that the provider information on this page 1s accurate If the information is correct press
14. aintenance Claims List Screen See Claims Submission on Page 11 for following steps Provider Contract Number Primary Insurance Info gt Cao Finish Claim Dates must be in mmddyyyy format BlueCross BlueShield of Alabama Line Item Information Batch List Claims List 51012345 Patient John A Brown XAA123456789 AANPAS 09 02 2003 Secondary insurance Info Patient info Service Info Line item Info Diagnosis Code1 Diagnosis Code2 Diagnosis Code3 Diagnosis Code4 382 9 461 0 Diagnosis Code5 Diagnosis Code6 Diagnosis Code7 Diagnosis Code8 To ensure correct processing all line item charges require a decimal point For example 5 00 five dollars 50 00 fifty dollars or 500 00 five hundred dollars 24 A Dates of B C D E F G J Procedures Services or Facility Sunplies eet DELETE AN EXISTING BATCH Access the Batch Submission Maintenance Batch List Screen 1 and click the batch you would like to delete This will take you to the Claims Submission Maintenance Screen 2 for your selected batch Click the Delete Batch button IMPORTANT NOTE BEFORE DELETING If the batch you wish to delete has a PENDING submission status the batch will be deleted and Blue Cross will have no further record of the claims Verify you have selected the correct batch prior to deleting as deleted batches CANNOT be retrieved If the batch you wish to delete has a SUBMITTED submission status Blue Cross do
15. all line item charges require a decimal point For example 5 00 five dollars 50 00 fifty dollars or 500 00 five hundred dollars me bpp k T Fpp Dates of Procedures Services or Tarvi Facility Supplies Iype TOs Diagnosis Code Pointer oe Charges e ot ae F T Code CPTYHEPCS eke Modifiers 09022003 99 05 i El e E f 2 f7o 25 25 o90 2003 aoe Select the appropriate code from the drop down box Valid values for column E are diagnosis code pointers 1 2 3 or 4 associated with the diagnosis codes above that were entered on the previous page Professional WebClaims User Manual Rev 10 01 2003 Page 10 of 18 Claims Submission CLAIMS SUBMISSION MAINTENANCE Claims List A listing of all claims in the selected batch The claim you just entered should now appear in the claims list along with the total claim amount BlueCross BlueShield You may now choose Add New of Alabama Claim to enter additional claims Claims Submission Maintenance r Batch List Repeat steps starting on Page 7 Batch Type Professional Created By Jane s Daily Batch Provider Key 51012345 OR Provider Name John J Smith MD Contract Number Date of Service Patient Acct No Patient Name Claim Amount Once Jon have keyed all claims XAA123456789 2003 09 02 987654321 BROWN JOHN 155 00 for your batch select the Submit Batch button to submit your claims Click on the Delete button
16. d a Date of Service for the claim Then click the Submit button Please note that the required fields are denoted with an asterisk Required fields are Contract Number First Name Last Name Date of Birth and Date of Service NOTE If multiple dates of service are used enter the last date most recent of the date range Professional WebClaims User Manual Rev 10 01 2003 BlueCross BlueShield of Alabama Claims Submission Maintenance Batch List Batch Type Professional Created By Jane s Daily Batch Provider Key 51012345 You have no claims Click on the Delete button to delete the batch that contains all the above listed claims Delete Batch You must add at least one claim to be able to submit a batch Provider Billing ID ProviderAccess Home Sign out For questions or problems with these web pages please e mail Blue Cross and Blue Shield Corporate Support Center or call 205 220 6134 This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association aon BlueCross BlueShield of Alabama Member Information Batch List Claims List Please enter the member s information Required fields are denoted with an Contract Number XAAt 23456789 First Name Jonn Middle Initial fa Last Name Brown Date of Birth 10161970 anmpyry Gender
17. er 12 0 00 Pending 09 11 2003 Professional 09112003 3 0 00 Pending oO BlueCross BlueShield Select the type of batch you of Alabama would like to create Professional Dental or Home Health Select the type of batch you would like to create Ana f Please enter a name to help identify this batch ane s Daily Batch Enter a name to help identify your ia batch gt Add New Batch Batch List After selecting the batch type and Provider Billing ID ProviderAccess Home Sign out entering a batch Name press the For questions or problems with these web pages c6 9 c6 29 please e mail Blue Cross and Blue shield Corporate Support Center Enter key or click the Create ar call 205 220 6134 button This will create the new This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association batch AN IMPORTANT NOTE Dental Providers should refer specifically to the Dental WebClaims Manual Professional WebClaims User Manual Rev 10 01 2003 Page 6 of 18 CLAIMS SUBMISSION MAINTENANCE Claims List A list of all claims in the selected batch Click the Add New Claim button to add a new claim to the current batch Provider Name JohnJ Smith MD To continue adding a new claim enter the Contract Number of the insured First Name Middle Initial Last Name Date of Birth Gender an
18. es keep record of the batch because the claims have already been received for processing Submitted batches are kept available on this page for your informational use and can be deleted at any time TIP Many providers will delete SUBMITTED batches after claims have been verified on the audit trail and or remittance 1 cy BlueCross Aloe Shield i A labana Batch Submission Maintenance Poolestional Dental Home Health Provider Key 51012345 Poovider Name John J Smith MD Add New Baich Claims Comat Total Amoani Sukmiiied Ww Siah Date Created Baich Type Created By diaid 6 Profemond EibenTer i L Tutmad 010203 Denial Fabbri oat 1 Sd 2 Subsratied OARS Moms Health sgt 1 pae Feneig UVES Frofeemond piita Tiri ri Di 4s Paing C1TOS Professional OM Test i Lai i Pendag DATM Profesiona ULONG 1 Loui Sutaretie dl Ura Ts Dental danba barchtect 4 Ou Peo idid 6 Frofsemone HIRAATESTFILE 7 et Tubman MASHI Hows Health GUPAATESTPILE 3 S000 Suberatted Eva Professional Deel 1 ami Pendeng EARL ETS Prafedmiar al feces iz Ou Penden Huet ross Boe Shiela of Alabama Claims Submission Maintenance Baich Let Batch Type Frolessional Provider Kay 51012345 Provider Mame John J Smith MD Add Mes eum Camre Numer Date of serice Patient Arri Ma Patient Mamre laim Anon i Stee a ral EAE H Created By Jane s Daily Baich Click on the Delete hartion ia delete the batch that comains all the ahbowe li
19. explain ing why it was rejected E Audit Reports Microsoft Internet Explorer 218 x File Edit View Favorites Tools Help Back Address Links gt Ea Select Different Provider Select Different Date ProviderAccess Sign Out Help A A SF BOB 4 wt i gt ofz O ADIAE S Va Tt SD 4 580 AUD E r i Bookmark v lt 2 SL Provider ID BlueCross BlueShield ga P1099999 of Alabama g 510xxxxx oom 51 Oxxxxx v el 510XXXXX I a AUDIT REPORT E 51 0xxxxx 51 0xxxxx Ln 7 DSi 00000 ee ee eee Lee eee g 510xXxxx CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES a Heit BSP999999910 PATIENT10 T C 03 21 03 03 21 03 205 00 5 E Mi edirk CLAIM NBR 551 1110010 51 Oxxxxx 13740238 1510xxxxx IN O G OO E of 510xxxxx CLAIMS ACCEPTED 10 FOR H 2 RU f Rigen eee Renee nana aes gba eae gi alten Sal fr 91 Oxxxxx PROVIDER 51099999 TEST PROVIDER1 REJECTED CLAINS A 510xxxxx J hT SE CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES i BBC999999911 PATIENT11 P 03 03 03 03 03 03 32 00 HCPC MODIFIERS 88142 TST00303 1010213 LINE ERROR 414 lt MESSAGE gt PROC 88142 INVALID FOR SEX CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIN CHARGES _ xaagg9999912 PATIENT12 A 03 20 03 03 20 03 32 00 al nn Done l Internet NOTE Remember that errored clai
20. il Rll eat current occupation D From c 17a UPIN of Referrina Physician Page 9 of 18 PROCEDURE INFORMATON Line Item Information This section contains the information related to the medical services rendered to the patient by the provider The field number corresponds to the box number on the HCFA 1500 CL 4 form You may key up to 10 line items on this screen After completion click the Finish Claim button If there are no errors the claim will be accepted and you will be forwarded to the Claims Maintenance Submission Claims List If you have more than 10 line items you must add a new claim to enter the additional line items NOTE The Total Charges field at the bottom of this page will stay at 0 00 as each line item is entered You will see a claim total amount on the next page after clicking Finish Claim The Reset Form button will clear all line item data you have entered eae BlueCross BlueShield of Alabama Line Item Information Batch List lawrns List Provider 51012345 Patient JOHN BROWN Contract Number 4412735456789 Service Date 09 02 2003 Primary insurance into secondary Insurance into Patient Info Service info Ling ltem into Diagnosis Code1 Diagnosis Code Diagnosis Code3 Diagnosis Coded 382 9 461 0 Diagnosis Code5 Diagnosis Code6 Diagnosis Code Diagnosis Coded Finish Claim Reset Form Dates must be in mmddyyyy format To ensure correct processing
21. laims User Manual Rev 10 01 2003 Page 12 of 18 Special Note Select the option for HIPAA Submissions if your batch of claims was submitted after 10 01 2003 If the batch was submitted prior to 10 01 2003 then select the option for Non HIPAA Submissions To view Audit Reports enter your Submitter ID which is also referred to as Client ID or Billing ID Click Submit to continue To view all audit reports for this Submitter ID select ALL To view an audit report for an individual provider select the desired provider number Click Submit when finished BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agout Us CONTACT Us Provider Access Audit Report Applications HIPAA Submissions including WWebClaims submitted on our after 10 1 4003 Mon HIPAS Submissions including YvebClaims submitted prior to 10 1 4005 Customers Employers Healthcare Providers Product amp Senices About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES AgouTuUs ContactUs ProviderAccess hlenu Sign Out Help Enter Submitter ID Number Please enter a
22. lephone 205 555 5555 25 Federal Tax ID Number 123456789 gt cone Provider Billing ID ProviderSccess Home Sidgn out For questions or problems with these web pages please e mail Blue Cross and Blue shield Corporate Support Center or call 205 220 6134 This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association 10 01 2003 Page 5 of 18 BATCH SUBMISSION MAINTENANCE Batch List A listing of pending and submitted batches Click the Add New Batch button to create a new batch of claims BlueCross BlueShield of Alabama Batch Submission Maintenance Professional Dental Home Health Provider Key 051012345 Provider Name John Smith lt gt Date Created Batch Type Created By Claims Count Total Amount Submitted Submission Status 01 03 2003 Professional EthanTest 2 1 138 35 Submitted 01 03 2003 Dental EthanTest 1 564 23 Submitted 01 07 2003 Home Health Test 3 234 56 Pending 01 08 2003 Professional Scott s Test 2 261 45 Pending 01 10 2003 Professional DM Test 7 1 400 00 Pending 01 17 2003 Professional 01172002 1 10 00 Submitted 03 26 2003 Dental dental batch test 5 0 00 Pending 07 02 2003 Professional HIPAATESTFILE 7 920 81 Submitted 07 02 2003 Home Health HIPAATESTFILE 3 520 00 Submitted 07 29 2003 Professional Test 1 0 00 Pending 08 04 2003 Professional test
23. ms have not been accepted by Blue Cross and we keep no further record of them These claims should be corrected and resubmitted as new claims Professional WebClaims User Manual Rev 10 01 2003 Page 16 of 18 Other Functions EDIT A CLAIM PRIOR TO SUBMISSION NOTE Claims can also be viewed AFTER are necessary a corrected claim must be resubmitted on paper 1 Access the Claims Submission Maintenance Claims List Screen and select the claim you would like to edit 2 Locate data to be changed If data is not on first page you may click Continue to advance to the next page OR click on the red link to advance directly to the desired page 3 After making the changes you must select Continue in order to save them prior to leaving the screen Professional WebClaims User Manual Rev 10 01 2003 submission but cannot be edited If changes aU BlueCross BlueShield of Alabama Claims Submission Maintenance Batch List Batch Type Professional Created By Jane s Daily Batch Provider Key 51012345 Provider Name John J Smith MD Contract Number Date of Service Patient Acct No Patient Name Claim Amount XAA123456789 2003 09 02 987654321 BROWN JOHN 163 00 Click on the Delete button to delete the batch that contains all the above listed claims Delete Batch Click the submit button to send the batch for processing by BCBSAL Submit Batch Provider Billing ID ProviderAccess
24. roup or FECA Number 12345 NOTE If the Continue button does not advance you to the next step check the page for any errors marked with a RED Question mark Place your mouse pointer over the question mark s for error details After errors have been corrected click the Continue button again to advance to the next step SECONDARY INSURANCE INFORMATION This section contains the patient s secondary insurance information The field number corresponds to the box number on the HCFA 1500 CL 4 form Some information on this screen may be populated automatically based on the contract number keyed and member selected when adding the claim Read each field carefully and make any necessary changes If you answered Other Insurance to question 11 d Is there an additional insurance plan on the Primary Insurance Information Screen you will be forwarded to the Secondary Insurance Screen Otherwise you will be forwarded to the Patient Information Screen as in the next section below Fill in the appropriate information on the Secondary Insurance Screen and click the Continue button to save your information and advance to the next step The Reset Form button will return all data fields back to the original values Professional WebClaims User Manual Rev 10 01 2003 BlueCross BlueShield of Alabama Secondary Insurance Information Batch List Claims List Provider 51012345 Patient
25. s Provider Inquiry Custonien Service General Prowider Inquiry o 205 93 23 Automated voice Response Unt only 000 Hema Automated Voice Respon e Une only o AB 93 016 Aubornited Voce Bespoke Une wilh Hipnesirialme aeadakilily for prnaders who do mot hawe access to ihe toll free number e Group Specific Prowider inguin o Federal Employee Program FEF R prefix B00 492 8872 Bellsouth 0S and DLS prafizes OUD 292 0002 o FAR pim AO 735 4164 o Uniroyal 800 3734 3041 o Nasto 200 Adah General Electric 300 655 5392 ITS Onter Plan Telaprocessing System Eligibility and Danefits Inquiry Click on the Ok button to 4 continue Security Alert x Ti You are about to view pages over a secure connection Any information you exchange with this site cannot be viewed by anyone else on the Web T Inthe future do not show this warning H More Info Select the desired ProviderAccess 5 application by clicking the associated link provideraccess your secure link to Blue Cross sign in TO A Welcome to ProviderAccess your secure sign in for Enter your provider or clinic ID and password all Blue Cross and Blue Shield of Alabarna e Sign in Practice Management and InfoSolutions ie transactions Use this single secure sign in page 51 012345 for access to Claim Payment Information and USER Patient Account Information Primary Care Physicians will also use this sign in for access
26. sted claims Delve Each Chick the submit button to send the batch tor processing by BCBS AL Atleast one of the chain in thie batch has a total charge of taro of come invalid walnet Please w nihy chains Brine dueling ia Broad ariu pi Aor Sn cig PRINT A BATCH LIST Access the Batch Submission Maintenance Batch List Screen and click on your browser s print button PRINT A CLAIM LIST Access the Claim Submission Maintenance Claims List Screen and click on your browser s print button Professional WebClaims User Manual Rev 10 01 2003 Page 18 of 18
27. submitter ID to view Audit Reports Click Submit when finished Submitter ID web1xxxx en E Customers Employers Healthcare Providers Products amp Senrices About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agourt Us CONTACT Us Providertccess Menu Sign Out Help Select Provider Number To view all audit reports for this Submitter ID select ALL To view an audit report for an individual provider select the desired provider number Click Submit when finished Provider Number ALL 51 0xxxxx 510xxxxx 510xxxxx 510xxxxx 510xxxxx 510xxxxx 510xxxxx Customers Employers Healthcare Providd 54 Qxxxxx Blue Cross and B 510xxxxx 510xxxxx ervices About Us Contact Us pama This site and all contents are Copyright ram AL Ew and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association Professional WebClaims User Manual Rev 10 01 2003 Page 13 of 18 BlueCrossBlueShield ra of Alabama The Caring Company Click on the drop down list and i selec t a da te for the Au di t Report Seve aT Sane PROVIDERS Propucts amp Services AgsouTUs Con
28. t off time for submission i oxxxxx G NESSAGE gt TRANSACTION SET 0204 CONTAINED NO LEVEL 1 X12 ERRORS of claims is 3 30 PM CST 9151 010000 CONTROLNUM 000000205 INTERCHANGE DATE 030421 INTERCHANGE TIME 1246 i a Pai lt MESSAGE gt TRANSACTION SET 0205 CONTAINED NO LEVEL 1 X12 ERRORS and if received after that 5 pene lt MESSAGE gt TRANSACTION SET 0205 CONTAINED NO LEVEL 2 IG ERRORS py 10xxxxx CONTROLNUM 000000204 INTERCHANGE DATE 030421 INTERCHANGE TIME 1246 time the file will be proc CONTROLNUM 000000205 INTERCHANGE DATE 030421 INTERCHANGE TIME 1246 essed the next business day lt MESSAGE gt BATCH ACCEPTED NO DUPLICATE FOUND f W 4 10f24 M 65xiin O R W a i Internet PRINTING TIP The Adobe Acrobat print function must be used to print the complete Audit Trail Report Click on the printer icon in the Adobe Acrobat Reader toolbar Z Audit Repr ts Microsoft Internet Explorer E l le x File Edit View Favorites Tools Help 4 Back Address Links El The accepted claims portion of the audit report contains a list of all claims that were accepted for processing Each of these claims is assigned a control number This is a claim number that can be used to track the claim throughout processing This claim number confirms receipt of your claim but does not guarantee payment Select Different Provider Select Different Date ProviderAccess Sign Out Help BSb A g BOA B
29. t the id Patient Medical Information bottom of your current page to e Claim Information D o Claim Entr ebClaims 5 o Audit Trail be taken to this Screen o Audit Trail Error Descriptions o Claim Status o Upload NSF Claim File Otherwise refe er to Oe aeons Remittance Report Page 3 Easy Steps to Professional Online Remittance Report ProviderAccess for instructions o Bhama y Onie Bemilance a on how tO reach this page i eerie eee File Institutional Activity Summary Report e Fee Schedules PMD Fee Schedule Chiropractor Fee Schedule DME Fee Schedule Home Health Fee Schedule Hospice Fee Schedule Preferred CAT Fee Schedule Preferred MRI Fee Schedule Preferred OT and HT Fee Schedule Preferred PET Fee Schedule Preferred PT Fee Schedule Fee Schedule Individual Code eo0o00000 0000 e Guidelines and Policies o Fragmented Coding Edits o Medical Policies o CURP Medical Necessity Guidelines Primary Care Network PCN o Covering Physicians o PCN Cost Profile o Review Referral o Submit Referral o Unique Provider Identification Number UPIN Reference Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association Professional WebC
30. tactUs Select Date Then click Submit to view this This application allows you to view your Audit Report for specific dates Choose a Date and then click Submit report on the screen You will also Submitter ID Web1xxxx be able to print this report Provider Number ALL Select Different Provider Date July 16 2003 Audit Report Format m E Foon To view the Audit Report as a Portable Document Format PDF file you will need Adobe Acrobat Reader free software that lets you view and print PDF files If you do not already have this software installed on your computer you may install it by selecting the Adobe Get Acrobat Reader box below duly 16 2003 Click on the Get Acrobat Reader icon to download Adobe Acrobat To view the Audit Report as HTML no additional software is required Note that when printing your audit reports the PDF format should be utilized Printing in HTML format is not recommended Audit reports are currently only available for 9 days prior to the HIPAA update but after the update then the audit reports will be available for 60 ee pendent Licensee of the Blue Cross and Blue Shield Association Customers Eb lovers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama E Electronic Data Interchange Instructions Page Microsoft Internet Explorer Eile Edit View Favorites Tools Help Address ntips
31. the Enter key or click the Continue button If the information is not correct select the Back to Login Page link and re key your information If information 1s still incorrect contact your Network Data Operations Representative for assistance If you need to make changes to the data associated with your provider number a Provider Change Notification form can be obtained by selecting the Provider Services link then by selecting Forms and then the second option under Enrollment Professional WebClaims User Manual Rev aa BlueCross BlueShield of Alabama ProvideriBilling Identification Plan Code 510 1 Provider Number 12345 2 Please Enter Billing ID web1xxxx 3 y Submit Reset ProviderAccess Home Sign out For questions or problems with these web pages please e mail Blue Cross and Blue Shield Corporate Support Center or call 05 220 6134 This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Crass and Blue Shield Association D Y BlueCross BlueShield of Alabama Provider Billing Information Provider Information Billing Information Name John J Smith MD Name Physician Clinic Inc P C Address 100 Smith Street Address 100 Smith Street Suite 100 Suite 100 City Birmingham City Birmingham State AL State AL Zip 35244 Zip 35244 Provider Number 51012345 Provider AlphaKey SMI Provider Office Te
32. to Primary Care Network transactions Password CLICK HERE DOWNLOAD MANUALS BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ABOUT Us Contact Us Return to Providers ProwderAccess User Manuals Sign Out Help icome to ProviderAccess You are signed in as 51012345 Please select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function kkkkkkkk SEURUE or Register Now Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association TIP You may bypass steps I and 2 by adding the above page to your list of favorites Based on the browser you are using select Bookmark or Favorites and select the add feature This will allow you to access the ProviderAccess Sign In page directly Professional WebClaims User Manual Rev 10 01 2003 e Patient Information Eligibility and Benefits o Summary Plan Description fa B Patient Medical Information e Claim Information Claim Entry WVebClaims New Audit Trail Audit Trail Audit Trail Error Descriptions Claim Status
33. ugh a screen however don t forget to select the Continue button to save your data prior to leaving the screen 3 Be patient when selecting link and navigation buttons Do not double click or click a link several times When entering WebClaims you must always use the Continue and Finish buttons to save your data prior to leaving the screen 4 To select a field using a mouse Move the mouse pointer to the information to be selected Depress or click the left mouse button once The item is selected if the information you choose is highlighted by color shading 5 To select a field without using a mouse Use the Tab key to move the cursor to the item you would like to select The item is selected if the information you choose is highlighted by color shading 6 To select a button choose one of the following Move the mouse pointer to the button and depress the left mouse button once or Press the Tab key until a dotted line appears around the word and then press the Enter button Professional WebClaims User Manual Rev 10 01 2003 Page 2 of 18 Easy Steps to Provider Access www bcbsal com Click Healthcare Providers on the 1 Blue Cross and Blue Shield of Alabama home page BlueCrossBlueShield of Alabama The Caring Company FOR YOUR HEALTH Information For a Healthy Safe Lifestyle ALABAMA DOCTOR FINDER NATIONAL DOCTOR FINDER P

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